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News--
Easing Depression Without Drugs
By Kate Murphy
May 02, 2005
BusinessWeek - Doctors are trying therapies, from implants to herbs, that can cut
down on side effects
Depression affects approximately 18.8 million
adults in the U.S. and is the nation's leading cause of disability. Yet mental
health experts say the front-line treatment for serious cases, antidepressant
drugs, works only about half the time and can have troubling side effects, such
as weight gain, sexual dysfunction, and even suicidal behavior. As a result,
there has been renewed interest in finding nonpharmacological approaches to
treating depression other than psychotherapy, which psychiatrists say is often
ineffective by itself.
Research is ongoing, but promising
nondrug therapies have emerged over the last decade. One source of optimism is
transcranial magnetic stimulation, or TMS, a noninvasive procedure that
activates the brain's emotive centers. While it's still under investigation,
there is strong evidence that it has antidepressive effects, says Dr. Sarah
Lisanby, associate professor of psychiatry and director of the magnetic
stimulation laboratory at Columbia Medical School. In this procedure,
doctors hold a paddle-shaped device emitting a powerful magnetic field over the
patient's forehead, causing neurons in the prefrontal cortex of the brain to
fire. "This is a region of the brain known to be underactive when a person is
depressed," says Dr. Lisanby. In this regard, TMS is similar to
electroconvulsant therapy, during which a patient's brain receives a powerful
electric shock. Although ECT helps patients about 80% of the time, it requires
anesthesia and can induce memory loss. TMS is performed without sedation and
does not cause amnesia. A list of researchers conducting TMS clinical trials can
be found at www.ists.unibe.ch. A more invasive approach is a
surgically implanted pacemaker-like device that stimulates the vagus nerve in
the neck. The Food & Drug Administration had already approved the so-called
neurostimulator, manufactured by Cyberonics (CYBX ), for treating
epilepsy when it gave preliminary approval in February for its use in managing
depression. The company hopes to get final approval by yearend. "This all came
about because the epilepsy patients with the device reported improved mood,"
said Dr. Mark George, professor of psychiatry and neurology at Medical
University of South Carolina in Charleston. He's a lead investigator in a
clinical trial that found the unit had the same effect for severely depressed
individuals. It costs about $25,000 to have the neurostimulator implanted in the
chest with wires running up to the neck. Patients can expect a recurring $15,000
expense to replace the battery every 5 to 10 years.
LIGHT
DOSAGE
The psychiatric community is also placing more stock in herbs
and dietary supplements. Although studies in the U.S. have been mixed, St.
John's Wort is gaining more acceptance as a depression remedy, several
psychiatrists say. The response rate for the herb is slightly lower than it is
for drugs like Prozac and Zoloft but with fewer side effects, says Dr. David
Mischoulon, assistant professor of psychiatry at Harvard Medical School. At a
standard dose of 900 mg to 1200 mg per day, stomach upset and light sensitivity
are probably the worst you can expect. Several studies in the U.S. and Europe
also show that 1 gram of fish oil per day or 400 mg to 1,600 mg daily of SAMe,
an amino acid derivative, work about as well as St. John's Wort.
Light
therapy can chase away the blues, too. Studies indicate that sitting in front of
a briefcase-size light box for 30 minutes a day can improve mood even among the
severely depressed. The boxes cost $150 to $300 and are often covered by
insurance if prescribed by a physician.
Exercise may be the least
expensive strategy. Recent clinical studies have shown it's as effective as
antidepressants in improving mood. An appropriate dose is three hours of
moderate activity per week, says a study published in the January, 2005,
American Journal of Preventive Medicine. "The kind of exercise is
probably irrelevant as long as you do it long enough," says Andrea Dunn,
director of behavioral research at the Cooper Institute in Denver and study
co-author. It's possible to walk away from your woe.
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